Are we all ‘Fit for Work’? The NHS and its 5 year plan.

The health section of the Conservative manifesto contained many references to the 5 year forward view (5YFV) produced by NHS England. Now that they are in power this document, and plans for its implementation, will set the landscape for how the NHS develops over time. In June I attended an event hosted by the think tank 2020health where the speaker was Simon Stevens CEO of NHS England. What was particularly interesting to me was that Simon used a significant part of his speech to address the issue of improving the health of the workforce. There have been many excellent reports in the past from Carol Black in particular about the need to give this issue priority but until now I have not seen NHS England “get it”. I think things are about to change.

The 5YFV already contains plans for NHS support to help people get and stay in employment. It recognizes that there is evidence that well targeted health support can help keep people in work thus improving their wellbeing and preserving their livelihoods. And mental health problems now account for more than twice the number of Employment and Support Allowance and Incapacity Benefit claims than do musculoskeletal complaints. The employment rate of people with severe and enduring mental health problems is the lowest of all disability groups at just 7%. So what is being done now to address these issues?

A new government-backed Fit for Work scheme started this year. In England it will be provided by Health Management Limited. The roll-out of the referral service started on 9 March. Initially referrals will be through GPs, but employers will be able to refer eligible employees for an occupational health assessment from the autumn.

I am not sure how many GPs will use the service but, if it is effective, I can see a lot of employers doing so.

Fit for Work is free. It provides an occupational health assessment and general health and work advice to employees and employers. It will complement, and not replace, existing occupational health services provided by employers (including through insurance based schemes).

From 1st January the Government also introduced a tax exemption of up to £500 (per year, per employee) on medical treatments to help their employees return to work. The medical treatment must be recommended to help the employee return to work after a period of absence due to ill health for at least 28 days. Also, the medical treatments must be recommended by a healthcare professional from Fit for Work or from within the company’s own occupational health service for the tax exemption to be applicable.

The 5YFV envisages a win-win opportunity of improving access to NHS services for at-risk individuals while saving ‘downstream’ costs at the Department for Work and Pensions, if money can be reinvested across programmes. It also sees merit in extending incentives for employers in England who provide programmes based on the National Institute for Health and Care Excellence recommended workplace health guidelines for employees. These guidelines cover supporting employees to be more physically active and reducing smoking and obesity.

The overall direction of travel in workforce health is increasing State support for prevention and early intervention either through State funded services or tax incentives for employers. What is not on the agenda is support for insurance based solutions. However the knock on effect could be to reduce the cost burden of prevention and early interventions for such schemes (potentially reducing group insurance scheme costs). And perhaps opening up a debate of how partnerships can be developed between what the State supplies and funds and the rehabilitation provided by income protection schemes.

Written by SAMI Fellow Richard Walsh. First published in Cover Magazine, July 2015

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